Tuesday, August 2, 2011

How do YOU do Dissociation?

Wow! Where did I just go?
Its been almost ten months since a particularly brutal experience of rejection with my oldest son. I remember walking around for hours draining the energies of anger and rage the encounter stimulated. I did my best to avoid amplifying those negative emotions by not replaying the episode in my mind. A few months later though when I tried to recall details and write about the family dynamics involved, a foggy sensation filled my mind as numbness overcame my senses. Only in the last week have I been able to face the memories with any clarity of mind and emotional recollection of that day.

What exactly is Dissociation?

Evolution has equipped us with some magical powers of pain defense, with automatic dissociation one of those mysterious affects often labeled as a symptom of mental illness. Yet when the same powers within the human nervous system are employed to positive effect, like self hypnotized analgesia to avoid pain, the only label we find is a wondrous Wow! Of admiration. As I wrote in the article meaning and mania, during my therapist training, I sat in stunned silence watching video footage of a 65 year lady with a history of bad reactions to anesthesia, lie calm and relaxed through a major operation, using only self hypnosis for pain control.

In the same article I talked about the hidden, unconscious power of our autonomic nervous system and its denied role in mental illness symptoms. We are indeed a curious creature, hard wired for external observation, with a peculiar resistance to awareness of what goes on beneath the conscious mind? Our knowledge of symptomatic mental anguish and its presumption of illness are by enlarge, external observations of behaviors and the minds assumptive perception. Consider typical descriptions of dissociation we find on the internet and in published medical literature.

Dissociation as a Mental Illness?
The DSM-IV considers symptoms such as depersonalization, derealization and psychogenic amnesia to be core features of dissociative disorders. However, in the normal population dissociative experiences that are not clinically significant are highly prevalent, with 60% to 65% of the respondents indicating that they have had some dissociative experiences.

Relation to trauma and abuse.
Dissociation has been described as one of a constellation of symptoms experienced by some victims of multiple forms of childhood trauma, including physical, psychological, and sexual abuse. This is supported by studies which suggest that dissociation is correlated with a history of trauma. Dissociation appears to have a high specificity and a low sensitivity to having a self-reported history of trauma, which means that dissociation is much more common among those who are traumatized, yet at the same time there are many persons who have suffered from trauma but who do not show dissociative symptoms.

Adult dissociation when comorbid with a history of child abuse and otherwise interpersonal violence-related posttraumatic stress disorder (PTSD) has been shown to contribute to disturbances in parenting behavior, such as exposure of young children to violent media. Such behavior may contribute to cycles of familial violence and trauma.

Symptoms of dissociation resulting from trauma may include depersonalization, psychological numbing, disengagement, or amnesia regarding the events of the abuse. It has been hypothesized that dissociation may provide a temporarily effective defense mechanism in cases of severe trauma; however, in the long term, dissociation is associated with decreased psychological functioning and adjustment.

Other symptoms sometimes found along with dissociation in victims of traumatic abuse (often referred to as "sequelae to abuse") include anxiety, PTSD, low self-esteem, somatization, depression, chronic pain, interpersonal dysfunction, substance abuse, self-mutilation and suicidal ideation or actions. These symptoms may lead the victim to erroneously present the symptoms as the source of the problem.

Child abuse, especially chronic abuse starting at early ages, has been related to high levels of dissociative symptoms in a clinical sample, including amnesia for abuse memories. A non-clinical sample of adult women linked increased levels of dissociation to sexual abuse by a significantly older person prior to age 15, and dissociation has also been correlated with a history of childhood physical as well as sexual abuse. When sexual abuse is examined, the levels of dissociation were found to increase along with the severity of the abuse.

Dissociation in Everyday Life?
It is very common in talk therapy to ask an emotionally difficult question and watch the subtle posture shift as a client's mind is overcome by a strange sense of numbness, of momentary depersonalization perhaps? I remember one emotionally adventurous client, who likened the experience to the shock of injury.

She recalled having her fingers jammed in a car door, "you know how at first you can't feel a thing," she said while discussing emotional numbing, "its a bit like that, I guess." "Funny how we all use that word you, when recalling personal experiences, instead of I," I said in reply. "A mini dissociation, perhaps?" She said laughing and shaking her head at the feelings beneath her comment.

It seems that only when such numbing experiences become unusually disruptive do we label a common experience as an illness? Even in the official medical model of disease it is well accepted that up to 65% of the population experiences milder forms of dissociation, suggesting a common stimulus within our brain/body systems?

Beyond the perception of disease affected states, other areas of medical research see a bigger picture of dissociation. For decades body psychotherapists have known that trauma and its dissociative affects, is as much about what happens within the body as in the brain. In fact the latest breakthrough in neurobiology confirms that the likely cause of many mental disorders, lies within a poorly understood and unconscious brain/body autonomic nervous system.

Dissociation as the Human Condition?
The human mind is dissociation, without this state there would be no special self awareness for humans? Without the dissociative state we would still be subject to the same instinctive reactions as the rest of the animal kingdom? My own recovery from 31 years of these altered states of mind only came with an education into my neurobiology.

In 2007, when I first started reading the mind numbing pages of academic jargon that describe the human body/brain/mind, I fully expected to learn more about brain disease. I found no specific information on brain disease which might explain my bipolar disorder, yet found a lot of information on how my nervous system affects my brains chemistry.

In short, I came to understand how unconscious nervous system activity stimulates my altered states, my dissociative experiences. With practice and ongoing experience I've learned to sense this unconscious activity by letting go of thoughts, learning to feel the nervous activity of my body, which has its own awareness beneath the conscious mind.

The non disease view of Dissociation?
"Dissociation as a clinical psychiatric condition has been defined primarily in terms of the fragmentation and splitting of the mind, and perception of the self and the body. Its clinical manifestations include altered perceptions and behavior, including derealization, depersonalization, distortions of perception of time, space, and body, and conversion hysteria. Using examples of animal models, and the clinical features of the whiplash syndrome, we have developed a model of dissociation linked to the phenomenon of freeze/immobility. Also
employing current concepts of the psychobiology of posttraumatic stress disorder (PTSD), we propose a model of PTSD linked to cyclical autonomic dysfunction, triggered and maintained by the laboratory model of kindling, and perpetuated by increasingly profound dorsal vagal tone and endorphinergic reward systems. These physiologic events in turn contribute to the clinical state of dissociation. The resulting autonomic dysregulation is presented as the substrate for a diverse group of chronic diseases of unknown origin."
 The Neurophysiology of Dissociation and Chronic Disease Robert C. Scaer MD.

"Most traumatized individuals fulfill the criteria for a number of co-existing diagnoses, which usually include mood disorders, anxiety disorders, substance abuse and dependence disorders, eating disorders, somatoform disorders, and medically unexplained symptoms (Davidson, Jughes, Blazer & George, 1991; Faustman & White, 1989; Kulka, et al., 1990). These complications are reflected in the DSM-IV TR by the inclusion of more than 12 associated features of PTSD (American Psychiatric Association, 2000). The formal diagnosis of PTSD contains three diagnostic post-traumatic symptom clusters: symptoms indicative of intrusive reliving of the trauma, the avoidance and numbing symptoms, and symptoms of increased autonomic arousal. The episodic alternation between the avoidance and reliving symptoms “is the result of dissociation: traumatic events are distanced and dissociated from usual conscious awareness in the numbing phase, only to return in the intrusive phase” A Sensorimotor Approach to the Treatment of Trauma and Dissociation. Pat Ogden, Ph.D., Clare Pain, M.D., and Janina Fisher, Ph.D.

"There is currently an increasing awareness, indeed a palpable sense, that a number of clinical disciplines are undergoing a significant transformation, a  paradigm shift. A powerful engine for the increased energy and growth in the mental health field is our ongoing dialogue with neighboring disciplines, especially developmental science, biology, and neuroscience. This mutually enriching interdisciplinary communication is centered on a common interest in  the primacy of affect in the human condition. Psychological studies on the critical role of emotional contact between humans are now being integrated with biological studies on the impact of these relational interactions on brain systems that regulate emotional bodily based survival functions." An Essential Mechanism of Development, Trauma, Dissociation Allan N. Schore.

While traumatized humans don’t actually remain physically paralyzed, they do get lost in a kind of anxious fog,
a chronic partial shutdown, dissociation, lingering depression and numbness, a kind of “functional freeze.”
Page 52, "In an Unspoken Voice" Peter Levine.

Resolving Trauma in Psychotherapy. With Peter A. Levine, PhD

Our first glance reactions?
At first glance the above links may seem unrelated to "mental illness," and it is important to feel this reaction and ask "is my assumption rational or reactive?" The common link between all mental disorders is our unconscious autonomic nervous system (ANS), which simply cannot be grasped by the mind, it can only be felt. We all have an emotional comfort-zone which is regulated by the unconscious activity of the ANS, and it is the disturbance of that comfort-zone which fuels the reaction to so-called madness.

Watching Peter Levine engage with a PTSD sufferer is an emotional experience for many of us, who have suffered these altered states of mind. It's also an example of the time consuming effort required to bring a new awareness and healing to any individual. Its also uneconomic in our current paradigm of bottom line profits and available resources. As Allan Schore points out, we need a paradigm shift in our perceptive awareness and perhaps an acceptance of current human perception as a basic dissociation would be a good start?

Stephen Porges has introduced a new term for our "at first glance" unconscious reactions, he calls it "neuroception." In his paper on neuroception, he explains the millisecond activity of the ANS as we constantly scan the environment for threats or resources, while maintaining our unconscious comfort-zone. These new discoveries into our hidden motivations explain why we are not as conscious as we like to think, and why dissociation is a common experience and may not be a disease, even in very severe disorders?

Bipolar Recovery
Bipolar Condition
Bipolar Disorder States
Trauma Exit
Bipolar Instincts
Calming Your Bipolar Symptoms
Mania Dreams & the Roots of Psychosis
Neuroception An Unconscious Perception?